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CYSTIC FIBROSIS SERVICES, LLC
RRC340014-00 FORSYTH MEMORIAL HOSPITAL INC
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Covered Entity Details
Entity Name
FORSYTH MEMORIAL HOSPITAL INC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC340014-00
Entity Address
3333 SILAS CREEK PARKWAY
WINSTON SALEM, NC 27103
Medicare Provider Number
340014
Participating Start Date
7/7/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
7/29/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Geoffrey Gardner, SVP Finance
(336) 718-2078
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2020
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